ANGIOTENSIN II RECEPTOR ANTAGONISTS AND PROTEINURIA

  • Tanja Kök Oddelek za nefrologijo Klinični oddelek za interno medicino Splošna bolnišnica Ljubljanska 5 2000 Maribor
  • Radovan Hojs Oddelek za nefrologijo Klinični oddelek za interno medicino Splošna bolnišnica Ljubljanska 5 2000 Maribor
Keywords: proteinuria, angiotensin II receptor antagonists, ACE inhibitors

Abstract

Background. In numerous clinical studies that tried to identify risk factors for progressive renal function loss, the severity of proteinuria correlated with the rate of renal function loss. In patients with chronic renal disease and hypertension the angiotensin converting enzyme (ACE) inhibitors are the drugs of choice. ACE inhibitors have been shown to reduce proteinuria and have renoprotective effect. Angiotensin II receptor antagonists produce effects very similar to those of ACE inhibitors. Some recent clinical trials suggest that combination of ACE inhibitor with angiotensin II receptor antagonist may be more effective in reducing proteinuria than ACE inhibitor given alone.

Case report. The effect of combination therapy on reducing proteinuria in a patient with Henoch-Schönlein purpura is described in this article.

Conclusions. Angiotensin II receptor antagonists have the same effect on proteinuria and are as effective as ACE inhibitors. The possibility of additive effects of the two types of compounds on proteinuria has been tested yet only in small number of patients. Combination therapy may have a significant additive effect on reducing proteinuria.

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References

Remuzzi G. Abnormal protein traffic through the glomerular barrier induces proximal tubular cell dysfunction and causes renal injury. Current Opin Nephrol Hyperts 1995; 4: 339–42.

Remuzzi G, Ruggenenti P, Benigni A. Understanding the nature of renal disease progression. Kidney Int 1997; 51: 2–15.

Ruggenenti P, Perna A, Mosconi L, Pisoni R, Remuzzi G. Urinary protein excretion is the best independent predictor of ESRF in non-diabetic proteinuric chronic nephropathies. Kidney Int 1998; 53: 1209–16.

Julian BA. IgA nephropathy and related disorders. In: Greenberg A ed. Primer on kidney diseases. Second edition. San Diego: Academic Press 1998: 170–5.

Weidmann P, Schneider M, Bohlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: an updated metaanalysis. Nephrol Dial Transplant 1995; 10: 39–45.

Makki DD, Ma JZ, Louis TA, Kasiske BL. Long-term effects of antihypertensive agents on proteinuria and renal function. Arch Intern Med 1995; 155: 1073–80.

Hojs R, Kök T. Odrasli bolnik s Henoch–Schönleinovo purpuro in nefrotičnim sindromom. Zdrav Vestn 1999; 68: 437–40.

Haycock GB. The nephritis of Henoch–Schönlein purpura. In: Davison AM, Cameron JS, Grünfeld JP, Kerr DNS, Ritz E, Winearls CG eds. Oxford textbook of clinical nephrology. Oxford: Oxford University Press, 1998: 859–77.

Bjorck S, Mulec H, Johnsen SA, Norden G, Aurell M. Renal protective effect of enalapril in diabetic nephropathy. Brit Med J 1992; 304: 339–43.

Hannedouche T, Landais P, Goldfarb B et al. Randomized controlled trial of enalapril and beta blockers in non-diabetic chronic renal insufficiency. Br Med J 1994; 309: 833–7.

Kamper AL, Strandgaard S, Leyssac PP. Effect of enalapril on the progression of chronic renal insufficiency. A randomized controlled trial. Am J Hypert 1992; 5: 423–40.

Mann JFE, Reisch C, Ritz E. Use of angiotensin converting enzyme inhibitors for the preservation of renal function. Nephron 1990; 55: 38–42.

Rekola S, Bergstand A, Bucht H. Deterioration rate in hypertensive IgA nephropathy. A comparison of a converting enzyme inhibitor and betablocking agents. Nephron 1991; 59: 57–60.

Ruilope LM, Miranda B, Morales JM, Rodicio JL, Romero JC, Raij L. Converting enzyme inhibition in chronic renal failure. Am J Kidney Dis 1989; 13: 120–6.

Mann JFE (for the AIPRI investigators). ACE inhibition in chronic renal failure: a step forward. Nephrol Dial Transplant 1996; 11: 932–3.

Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensinconverting enzyme inhibition on diabetic nephropathy. N Engl J Med 1993; 329: 1456–62.

Klahr S, Schreiner G, Ichikawa I. The progression of renal disease. New Engl J Med 1988; 318: 1657–61.

Maschio G, Alberti D, Janin G et al. Effect of the angiotensin converting enzyme inhibitor benazepril on the progression of chronic renal insufficiency. New Engl J Med 1996; 334: 939–45.

Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal failure in proteinuric, nondiabetic nephropathy: GISEN group. Lancet 1997; 349: 1857–63.

Brunner HR, Christen Y, Munafo A, Lee RJ, Waebwr B, Nussberger J. Clinical experience with angiotensin II receptor antagonists. Am J Hypert 1992; 5: 243S–246S.

Wolf G. Molecular mechanisms of angiotensin II in the kidney: emerging role in the progression of renal disease: beyond haemodynamics. Nephrol Dial Transplant 1998; 13: 1131–42.

Peters H, Ritz E. Dosing angiotensin II blockers – beyond blood pressure. Nephrol Dial Transplant 1999; 14: 2568–70.

Schwarz A. New aspects of the treatment of nephrotic syndrome. J Am Soc Nephrol 2001; 12: S44–S47.

Brenner BM, Cooper ME, de Zeeuw D et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345: 861–9.

Lewis EJ, Hunsicker LG, Clarke WR et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345: 851–60.

Parving HH, Lehnert H, Brochner-Mortensen J et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001; 345: 870–8.

Russo D, Pisani A, Balletta MM et al. Additive antiproteinuric effect of converting enzyme inhibitor and losartan in normotensive patients with IgA nephropathy. Am J Kidney Dis 1999; 33: 851–6.

Menard J, Campbell DJ, Azizi M, Gonzales MF. Synergistic effects of ACE inhibition and AII antagonism on blood pressure, cardiac weight and renin in spontaneously hypertensive rat. Circulation 1997; 96: 3072–8.

Ruilope LM. Is it wise to combine an ACE inhibitor and an angiotensin receptor antagonist? Nephrol Dial Transplant 1999; 14: 2855–6.

Zoccali C, Valvo E, Russo D, Panichi V, Zuccala A. Antiproteinuric effect of Losartan in patients with chronic renal diseases. Nephrol Dial Transplant 1997; 12: 234–5.

De Jong PE, Navis G, de Zeeuw D. Renoprotective therapy: titration against urinary protein excretion. Lancet 1999; 354: 352–3.

Gansevoort RT, Navis GJ, Wapstra FH, de Jong PE, de Zeeuw D. Proteinuria and progression of renal disease: therapeutic implications. Current Opin Nephrol Hypertens 1997; 6: 133–40.

How to Cite
1.
Kök T, Hojs R. ANGIOTENSIN II RECEPTOR ANTAGONISTS AND PROTEINURIA. TEST ZdravVestn [Internet]. 1 [cited 5Aug.2024];71(3). Available from: http://vestnik-dev.szd.si/index.php/ZdravVest/article/view/1578
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Professional Article